MEDIAN NERVE PARALYSIS

THOMAS H. O'SHAY · 2026 · Case ID: A26035523

GRANTED

Summary

The Veteran, who served in the Army from May 1974 to April 1976, appeals the denial of service connection for bilateral carpal tunnel syndrome (CTS) of the upper extremities, a right ankle disorder, and a lumbar spine disorder secondary to the right ankle disorder. The Board reviewed evidence submitted after a November 2020 decision, including private medical opinions dated May 2025. The Veteran testified that his CTS was due to military mechanic work involving heavy equipment and hand strain, and that his right ankle injury in service led to chronic problems, abnormal gait, and subsequent lumbar spine issues. Service treatment records (STRs) showed normal findings for upper extremities at separation, but a later in-service injury to the right hand in March 1976 was noted. STRs also documented an in-service right ankle injury in May 1974. Post-service records showed Veteran presented with bilateral CTS in 2012, with prior documentation from the 1980s and 2009 nerve conduction studies. A June 2012 CT scan showed ossification of the right ankle ligament, suggesting old injury. A February 2012 MRI revealed lumbar disc herniation and spinal stenosis. Unfavorable VA opinions suggested less likelihood of service connection for CTS, ankle, and lumbar spine issues, citing lack of in-service complaints or diagnoses. However, favorable private opinions from May 2025 opined that the Veteran's bilateral CTS was at least as likely as not a direct result of his military mechanic service, citing medical literature. These opinions also found the right ankle disorder was likely due to the in-service injury and that the lumbar spine disorder was likely secondary to the chronic abnormal gait caused by the ankle injury. The Board found the evidence in relative equipoise, applying the benefit of the doubt. Service connection for bilateral CTS and the right ankle disorder was granted directly, and the lumbar spine disorder was granted secondary to the right ankle disorder.

Rationale

New and relevant evidence received post-November 2020 decision.; Evidence in relative equipoise.; Benefit of the doubt applied.; Favorable private opinions linked CTS to military mechanic service.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210716-172946

Full Decision Text

Citation Nr: A26035523
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210716-172946
DATE: April 16, 2026

ORDER

The Board having determined that new and relevant evidence has been received, readjudication of the claim of entitlement to service connection for carpal tunnel syndrome (CTS) of the right upper extremity is required.

The Board having determined that new and relevant evidence has been received, readjudication of the claim of entitlement to service connection for CTS of the left upper extremity is required.

The Board having determined that new and relevant evidence has been received, readjudication of the claim of entitlement to service connection for a right ankle disorder is required.

The Board having determined that new and relevant evidence has been received, readjudication of the claim of entitlement to service connection for a lumbar spine disorder is required.

Entitlement to service connection for CTS of the right upper extremity is granted.

Entitlement to service connection for CTS of the left upper extremity is granted.

Entitlement to service connection for a right ankle disorder is granted.

Entitlement to service connection for a lumbar spine disorder secondary to the now service-connected right ankle disorder is granted.

FINDINGS OF FACT

1. Additional evidence associated with the claims file since the November 2020 Board decision tends to prove or disprove a matter in issue with regards to the claim of entitlement to service connection for CTS of the right upper extremity.

2. Additional evidence associated with the claims file since the November 2020 Board decision tends to prove or disprove a matter in issue with regards to the claim of entitlement to service connection for CTS of the left upper extremity.

3. Additional evidence associated with the claims file since the November 2020 Board decision tends to prove or disprove a matter in issue with regards to the claim of entitlement to service connection for a right ankle disorder.

4. Additional evidence associated with the claims file since the November 2020 Board decision tends to prove or disprove a matter in issue with regards to the claim of entitlement to service connection for a lumbar spine disorder.

5. The evidence is in relative equipoise as to whether the CTS of the right upper extremity is etiologically related to service.

6. The evidence is in relative equipoise as to whether the CTS of the left upper extremity is etiologically related to service.

7. The evidence is in relative equipoise as to whether the right ankle disorder is etiologically related to service.

8. The evidence is in relative equipoise as to whether the lumbar spine disorder is secondary to the now service-connected right ankle disorder.

CONCLUSIONS OF LAW

1. New and relevant evidence has been received and readjudication of the claim of entitlement to service connection for CTS of the right upper extremity is required. 38 U.S.C. §§ 101 (35), 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

2. New and relevant evidence has been received and readjudication of the claim of entitlement to service connection for CTS of the left upper extremity is required. 38 U.S.C. §§ 101 (35), 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

3. New and relevant evidence has been received and readjudication of the claim of entitlement to service connection for a right ankle disorder is required. 38 U.S.C. §§ 101 (35), 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

4. New and relevant evidence has been received and readjudication of the claim of entitlement to service connection for a lumbar spine disorder is required. 38 U.S.C. §§ 101 (35), 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

5. The criteria for service connection for CTS of the right upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for CTS of the left upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a right ankle disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107

5. The criteria for service connection for CTS of the right upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for CTS of the left upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a right ankle disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a lumbar spine disorder secondary to the now service-connected right ankle disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from May 1974 to April 1976.

The appeal arises from a rating decision dated in April 2021; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the subsequent June 2021 notice of disagreement, the Veteran selected the Hearing review lane, and a Board hearing was held on April 14, 2025. As such, the Board will consider evidence at the time of the April 2021 rating decision and evidence received within 90 days of the Board hearing in April 2025. The Board will not consider evidence added to the record between the April 2021 rating decision and the April 2025 Board hearing, nor the evidence added following the expiration of 90 days from the Board hearing. If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.

In the April 2021 rating decision, the Agency of Original Jurisdiction (AOJ) made the following favorable findings: on VA examination in April 2012 the Veteran was diagnosed with herniated lumbar disc, spinal stenosis, nerve-root impingement, intervertebral disc syndrome (IVDS), and radiculopathy; on VA examination in 2013 he was diagnosed with carpal tunnel syndrome in the upper extremities; and on VA examination in 2012 he was diagnosed with ossification of right-deltoid ligament and chronic right ankle strain. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

Issues 1-4: Whether new and relevant evidence was received to readjudicate the issues of service connection for CTS of the upper extremities, right ankle disorder, and lumbar spine disorder.

New evidence means existing evidence not previously submitted to agency decisionmakers. Relevant evidence means evidence that tends to prove or disprove a matter in issue. 38 U.S.C. §§ 101 (35); 38 C.F.R. §§ 3.156(d) (New and relevant evidence), 3.2501 (Supplemental Claims).

A claimant may continuously pursue a claim or issue by filing a supplemental claim following notice of a decision by the AOJ or the Board. 38 C.F.R. § 3.2500(c). If new and relevant evidence is presented or secured with respect to the supplemental claim, the AOJ will readjudicate the claim taking into consideration all of the evidence of record. 38 C.F.R. § 3.2501. New evidence is evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim, including evidence that raises a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(2). If new and relevant evidence is not presented or secured, the AOJ will issue a decision finding that there was insufficient evidence to readjudicate the claim. Id.

In the November 2020 Board decision, the Board denied service connection for CTS of the upper extremities to include left upper extremity CTS as secondary to right upper extremity CTS, right ankle disorder, and lumbar spine disorder to include as secondary to the right ankle disorder. The Board determined that the right ankle disorder and lumbar spine disorder were not related to service, the lumbar spine disorder was not secondary to a service-connected disorder, arthritis of the lumbar spine and right hand osteoarthritis did not manifest to a compensable degree within one year of separation from service; CTS did not begin during service, was not related service, did not manifest to a compensable rating within one year separation from active service, and left upper extremity CTS was not secondary to a service-connected disorder. The evidence of record at the time of the November 2020 Board decision included service treatment records, post-service medical records, private opinions dated in June 2015 and August 2015, and VA examinations dated in September 2013 and July 2020.

Evidence received since the November 2020 decision includes a private opinion dated in May 2025 and received from the Veteran in June 2025 whereby the examiner opined that it is at least as likely as not that the Veteran's bilateral CTS resulted in pain and loss of function and was a direct result of his military service as a mechanic. In another private opinion dated in May 2025 and received from the Veteran in June 2025, the examiner opined that it was at least as likely as not that the Veteran's right ankle disorder was the direct result of his ankle injury in service. He explained that medical literature shows how one ankle injury, especially ankle sprains, can cause chronic laxity leading to multiple recurrences of sprains, eventually leading to chronic ankle sprain and instability as seen in the Veteran's case. The examiner also opined that it was at least as likely as not that the Veteran's low back disorder was secondary to his right ankle disorder as a result of the chronic abnormal gait. Thus, the evidence is new and relevant evidence and readjudication of the claims is warranted.

Issues 5-8: Entitlement to service connection for CTS of the upper extremities, right ankle disorder, and lumbar spine disorder.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d).

For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for arthritis and other organic diseases of the nervous system, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(a).

For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the disorder noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be granted on a secondary basis for a disability which was caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310.

Medical reports must be read as a whole and in the context of the evidence of record. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012).

During the April 2025 Board hearing
not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be granted on a secondary basis for a disability which was caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310.

Medical reports must be read as a whole and in the context of the evidence of record. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012).

During the April 2025 Board hearing the Veteran testified that his CTS of the upper extremities was due to service where he worked in an engineer unit, handled heavy equipment, and had a lot of activity that can cause CTS. He also noted that while working in a woodshop his right hand was caught in the back side of a thickness planer. He stated that he has had chronic problems with his right ankle since he injured it in service and his back disorder is due to falls he incurred as a result of the right ankle disorder.

Service treatment records (STRs) show the February 1976 separation examination indicates normal findings for the upper extremities. However, in March 1976, while still in active service, the Veteran presented with trauma to his right hand, incurred while working with a wood-planing machine. The x-ray was negative and the examiner prescribed an ACE wrap. The STRs show no subsequent presentations by the Veteran with complaints or reports concerning this injury. STRs show in May 1974, the Veteran presented with complaints of soreness and pain for one day in his right ankle and foot, noted by the examiner as due to jumping off some steps and twisting the ankle. The Veteran exhibited current signs of swelling, stiffness, discoloration, and tenderness. Physical examination confirmed an inversion injury, tenderness, and swelling. STRs show the February 1976 separation examination indicates the examiner found "spine, other musculoskeletal" to be normal, with an abnormal notation and with a seemingly unrelated to that body segment, it noted hyperpigmented areas of the Veteran's face caused by recent second-degree burns the Veteran had suffered while stationed in West Germany.

The Veteran's DD 214 Form shows his military occupational specialty was carpenter and he was assigned to an engineer battalion. During the March 2019 hearing the Veteran testified that he was assigned to an engineer unit and there was constant use of the hands and wrist with tools and heavy construction methods.

As for CTS of the upper extremities, the post-service record shows the Veteran presented to VA in February 2012 with complaints of CTS in the bilateral upper extremities of increasing intensity, reporting he was unable to make a fist. The treatment provider noted the Veteran has a history "of CTS documented back in 80s, EMG/NCV [electromyograph/nerve conduction velocity test] 2009 by PMR [prior medical record] shows moderate [bilateral] carpal tunnel."

A VA treatment provider noted in March 2012 that a motor nerve conduction and sensory nerve conduction testing showed evidence of moderate bilateral sensorimotor axonal median nerve neuropathy at the wrist. She added, "(t)his is consistent with the clinical diagnosis of Carpal Tunnel Syndrome."

A September 2013 VA examination for hand and finger disorders shows a diagnosis of osteoarthritis of the first metacarpal joint of the right hand and normal left hand.

As for the right ankle disorder, in June 2012, the Veteran underwent a CT scan for a chronic ankle instability. The results revealed ossification of the deep component of the deltoid ligament, "likely due to old injury. The superficial component appears thickened [] also suggesting old injury." Additionally, although the anterior talofibular ligament (ATFL) was not well visualized, a "chronic rupture cannot be excluded. Anterior tibiofibular ligament appears thickened suggesting chronic sprain." Later that month the Veteran was assessed with chronic ATFL tear and foot pain.

As for the lumbar spine disorder, a February 2012 VA note states low back pain is likely a combination of degenerative joint disease and musculoskeletal strain/sprain. It adds that an MRI "will assess for progression of disc herniations." The February MRI which followed revealed disc bulge with a central disc herniation at L4-L5 resulting in severe central spinal stenosis, bilateral neuroforaminal narrowing and compression of the bilateral L5 nerve roots. Additionally, there was disc bulge with shallow
rupture cannot be excluded. Anterior tibiofibular ligament appears thickened suggesting chronic sprain." Later that month the Veteran was assessed with chronic ATFL tear and foot pain.

As for the lumbar spine disorder, a February 2012 VA note states low back pain is likely a combination of degenerative joint disease and musculoskeletal strain/sprain. It adds that an MRI "will assess for progression of disc herniations." The February MRI which followed revealed disc bulge with a central disc herniation at L4-L5 resulting in severe central spinal stenosis, bilateral neuroforaminal narrowing and compression of the bilateral L5 nerve roots. Additionally, there was disc bulge with shallow left paracentral/posterior disc herniation at L5-S1 resulting in mild central spinal stenosis, mild right and moderate left neuroforaminal narrowing.

The Board notes that a one-page VA note, associated with the claims file in July 2012, states the Veteran's lumbar spine disorder began in 1977 and was treated from that year at "Orthopedic and Chiropractic," the records of which are "older than 10 years, not accessible."

Prior to an April 2012 MRI at VA, the radiologist stated the Veteran's diagnosis as low back pain with radiculopathy. He noted the Veteran's reports of increased low back pain in the last 3 years, with numbness and pain in both lower extremities.

There are favorable and unfavorable opinions in the claims file regarding the etiologies of CTS of the upper extremities, right ankle disorder, and lumbar spine disorder.

As for the unfavorable opinions, the September 2013 VA examiner opined that the Veteran's bilateral hand disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness based on the rationale that it was more likely due to working as a remodeling contractor. On VA examination for peripheral nerves in July 2020, the examiner referred to 2013 diagnoses of CTS. She noted the Veteran's report of onset in 1975, with pain, numbness, and tingling in the hands/fingers. She opined for both right and left claimed CTS, is less likely than not caused by the in-service injury. In her rationale, she explained records are silent for the diagnosis, treatment, or complaints related to the right and left hand CTS in service. She acknowledges that the Veteran was seen during service in February 1976 for right hand trauma, however CTS is a nerve disorder and not a hand disorder. In September 2013, the Veteran underwent a VA examination for the ankle, in which the VA examiner, although noting the Veteran at some time had an ankle disability added as a diagnosis, "(n)ormal examination of the R ankle." The September 2013 VA examiner opined that the right ankle disorder was less likely than not incurred in or caused by the claimed in-service injury, event or illness. She explained that the Veteran did not currently have a right ankle disability. The Veteran was afforded a VA examination for the ankle disorder in July 2020. The examiner noted that available imaging studies did not document arthritis. She opined that the right ankle disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In the relevant part of her rationale she explained that records are silent for complaints related to the ankle until 2012. The July 2020 VA examiner for thoracolumbar spine diagnosed lumbar spine degenerative disc disease and right lower extremity radiculopathy. By the Veteran's reports, she noted that the date of onset for lumbar spine disorder was 1976, due to multiple falls caused by the Veteran's ankle disorder shortly after discharge from service. On examination, among other test results, this examiner found mild right lower extremity radiculopathy, no IVDS and available imaging studies did not document arthritis. She opined that the lumbar spine disorder is less likely than not caused by an in-service injury. She explained in her rationale that there are no records showing treatment, complaints, or diagnoses related to the back. Therefore, it is less likely than not caused by an in-service injury or disability. In regard to the question of the nature and etiology of any back disability, the July 2020 VA examiner's opinion and rationale were as follows: "degenerative disc disease is caused by the aging process/normal wear-and-tear." She also opined that it is less likely than not that the disability is related to an in-service injury, event or disease. To the question of whether the back pathology has other etiology,
the lumbar spine disorder is less likely than not caused by an in-service injury. She explained in her rationale that there are no records showing treatment, complaints, or diagnoses related to the back. Therefore, it is less likely than not caused by an in-service injury or disability. In regard to the question of the nature and etiology of any back disability, the July 2020 VA examiner's opinion and rationale were as follows: "degenerative disc disease is caused by the aging process/normal wear-and-tear." She also opined that it is less likely than not that the disability is related to an in-service injury, event or disease. To the question of whether the back pathology has other etiology, to include being due to right ankle pathology, the July 2020 VA examiner further opined that the back pathology is not related to the ankle. Her rationale again was degenerative disc disease is caused by the aging process/normal wear-and-tear, adding, "not by an ankle" disability.

As for the favorable opinions, in their August 2015 nexus letter, Dr. J.W.B. and Dr. L.W. note that there is documentary evidence of CTS manifesting in the 1980s, pointing to the February 2012 VA treatment note. Therefore, Dr. J.W.B. and Dr. L.W. state it is their shared opinion that the Veteran's "previous denial of service connection for bilateral CTS be reversed and granted service connection." The Veteran submitted an August 2015 nexus letter, produced by Dr. J.W.B. and Dr. L.W., in which they provide a current diagnosis of chronic right ankle pain and chronic right ankle sprain. They opined that these disorders are a result of the in-service ankle injury. Based on their review of the record, Dr. J.W.B. and Dr. L.W. stated: "(i)t is the shared opinion of [Dr. J.W.B. and Dr. L.W.] that there is sufficient evidence to demonstrate a current disability. Furthermore, more-likely-than-not; the inciting injury was incurred while on active duty and would thus constitute a primary service connected injury (emphasis in original)." They include portions of an article by a medical professional to provide clinical background to the workings of the ankle and the development of injuries. The Veteran submitted a June 2015 private Disability Benefits Questionnaire (DBQ) for the thoracolumbar spine, conducted by Dr. P.N., in which he stated April 2012 diagnoses for herniated lumbar disc, spinal stenosis, and nerve root impingement, adding that each was verified by the February 2012 MRI. From results of various testing, Dr. P.N. detected IVDS and noted that nerve conduction studies verify radiculopathy associated with lumbar-spine disorder. He concluded that, "due to chronic Rt ankle injury incurred while in the Army, Pt [patient] wears ankle support daily, causing aberrant weight bearing and subsequent lumbo-sacral dysfunction and radiculopathy." In a June 2015 medical statement, Dr. P.N. noted that, while in service, the Veteran "jumped and injured his right ankle which later caused a secondary back" disability. He opined as follows: "(it is also my opinion that it is more likely than not the physical trauma suffered during the Veteran's military service as noted in his record that caused, contributed to and aggravated the totally disabling back conditions." In the August 2015 nexus letter of Dr. J.W.B. and Dr. L.W., they stated: it "is the shared opinion of [Dr. J.W.B. and Dr. L.W.] that [the Veteran's] lower back disability more-likely-than-not, shares a secondary service connection with this history of military service, via his right ankle disorder. They explained that the Veteran's right ankle pathology has chronically affected his gait, posture and range of motion and the abnormal conformation during walking and standing has forced the Veteran to adapt and compensate, thereby causing mechanical stresses, resulting in lumbar spine degeneration, misalignment, and stenosis. They add that, as the spine is connected to the lower extremities by tendons, muscle and bones, the effects of one section of the limb could affect the gait, stance and posture enough to produce pathology in other areas of the musculoskeletal system.

Subsequent to the April 2025 Board hearing, in a private opinion dated in May 2025 and received from the Veteran in June 2025, the examiner indicated that the Veteran's service included being a mechanic and stated that he disagreed with the unfavorable VA opinion in June 2020 regarding CTS as the Veteran's work as a mechanic placed significant strain and vibrations on the musculature and soft tissues of his wrist, at least as likely as not causing his bilateral CTS. The examiner explained and cited to substantial medical literature that shows the link between occupations involving repetitive hand movements, forceful grips, and vibration, which is common in military mechanics, and the development of CTS. For example, a study found that occupations to include aviation, support equipment technician, engineman, hull-maintenance technician, boatswain's mate, and machinist's mate had significantly higher rates of CTS compared to other roles. The study was published in Archives of Environmental Health in September 1996 titled, "Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel." The examiner opined that it is at least as likely as not that the Veteran's bilateral CTS was a direct result of his military service as a mechanic. The Veteran's causation for his CTS due to his military occupation was consistent with other Veterans the examiner has treated.

In another private opinion dated in May 2025 and received from the Veteran in June 2025, the examiner noted that during service in 1974 the Veteran jumped off a step and landed on his ankle and was forced to perform a road march. A February 2012 x-ray shows ossification of the deep component of the deltoid ligament likely due to old injury. The May 2025 examiner disagreed with the unfavorable July 2020 VA opinion, pointing out the Veteran undoubtably experienced an ankle injury during his service as documented in his service treatment records. His MRI specifically noted his ankle disorder "suggesting old injury". Further, medical literature shows how one ankle injury, especially ankle sprains, can cause chronic laxity leading to multiple recurrences of sprains, eventually leading to chronic ankle sprain and instability as seen in the Veteran's case. Chronic ankle pain also is well known to lead to a chronic abnormal gait, which causes significant strain on the structures and musculature of the lumbar spine, leading to disorders such as the Veteran's lumbar spine degenerative disc disease, IVDS, and radiculopathy. The examiner cited extensively to medical literature that shows musculoskeletal injuries are underreported in the US Army, acute ankle sprain can lead to long lasting symptoms to include gait disturbances. The examiner opined that it was at least as likely as not that the Veteran's right ankle disorder was the direct result of service. His service treatment records show evidence of his first significant sprain during his service and he reported his right ankle disability has continued and progressed since his service. The Veteran's reported chronic right ankle pain was consistent with the medical literature following ankle sprains. The examiner also opined that it was at least as likely as not that the Veteran's low back disorder was secondary to his right ankle disorder as a result of the chronic abnormal gait. Medical literature shows how a chronic abnormal gait can cause abnormal strain and degeneration of the lumbar spine musculature and structures, over time causing and worsening lumbar spine disorders such as the Veteran's degenerative disc disease, IVDS, and radiculopathy. The examiner noted that the debilitating effects from these disorders are not acute in nature and may take many years to develop as in the Veteran's case.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary is required to give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Here, viewing the record in the light most favorable to the Veteran, the Board finds that the favorable private opinions dated in May 2025 and received from the Veteran in June 2025 put the evidence in relative equipoise as to whether CTS of the upper extremities and the right ankle disorder are due to service, and whether the lumbar spine disorder was caused by the right ankle disorder. The Board finds
positive and negative evidence regarding any issue material to the determination of a matter, the Secretary is required to give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Here, viewing the record in the light most favorable to the Veteran, the Board finds that the favorable private opinions dated in May 2025 and received from the Veteran in June 2025 put the evidence in relative equipoise as to whether CTS of the upper extremities and the right ankle disorder are due to service, and whether the lumbar spine disorder was caused by the right ankle disorder. The Board finds the May 2025 private opinions to be significantly probative as they were based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008).

As a result, the benefit-of-the-doubt rule applies, and the claims of entitlement to service connection for CTS of the right upper extremity, CTS of the left upper extremity, and a right ankle disorder are granted on a direct basis and the lumbar spine disorder is granted secondary to the now service-connected right ankle disorder.

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mac, M.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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